20th anniversary of landmark findings

May 2024 marks the 20th anniversary of the publication of papers on the role of the EGFR mutation in lung cancer. This is a seminal event that changed the history of this disease and that can be traced back to one reason why cancer mortality has been declining in the United States.

The Cancer Letter and the Cancer History Project explore this development in a comprehensive multimedia series consisting of opinion pieces, our real-time coverage, historical documents, and interviews with scientists, clinicians, drug regulators, and cancer survivors.

This multimedia series is guest-edited by Suresh S. Ramalingam, a lung cancer expert, executive director of Winship Cancer Institute of Emory University, and editor-in-chief of the journal Cancer.

This is the first story in a series that will explore the process of discovery of the EGFR mutation, the learning curve for using the drugs that target it, and the unparalleled impact on patients with lung cancer and other diseases.

When I started fellowship training in the year 2000, the response from everyone when I mentioned my interest in lung cancer was nearly the same: “Are you sure?”

“My visits with patients look dramatically different from the days I started practicing oncology; there is more hope for long-term survival and patients are thriving despite advanced stage lung cancer, for a large part.”

This experience was not unique to me; every thoracic oncologist at that time would likely relate to that. The basis was not hard to understand: lung cancer was a highly lethal disease, with practically one proven chemotherapy agent (platinum) that improved the 1-year survival rate by 10% for patients with stage 4 disease.

Even in uncommon situations where lung cancer was diagnosed at an early stage, survival was suboptimal despite complete resection. The stigma associated with tobacco smoking, lack of treatment options, and high mortality were driving the widespread nihilism for lung cancer.

It was not uncommon for patients to be directly referred to hospice following the diagnosis of lung cancer. In fact, the “Big Lung Trial” (published in 2004) compared platinum-based chemotherapy to best supportive care and demonstrated a 9-weeks improvement in median overall survival with the former. It hardly mattered if a patient had non-small cell lung cancer (NSCLC) (~85%) or small cell lung cancer (~15%).